Background Check Questionnaire

Background Check Questionnaire

The below is to be completed by applicants who want to volunteer at RCS.
This confidential questionnaire is to be completed by applicants to volunteer or for any employment at Redeemer Christian School or New Life Church @ Renton. Along with this survey, a Criminal History Check will be run with the Washington State Patrol. This standard procedure is being used to help us provide a safe and secure environment for those who participate in our programs and use our facilities. Hiring and continued employment may be contingent upon information received from the WSP.

Before starting the form, please select what campus you are wanting to volunteer at below:
Select a Campus Location*
Personal Information
If related to RCS student/s; Name: * Relationship: *
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Home Number
Cell Number*
D.O.B.*

MonthDayYear
Date
Race*
M/F*

MaleFemale
SS#*
Previous Names

List all previous names (maiden) and or alias' you have used.
Previous Residences

From 18 years to present
Year blanks* State Type a label* Countyblank* CityType a label*
Year blanks State Type a label Countyblank CityType a label
Year blanks State Type a label Countyblank CityType a label
Year blanks State Type a label Countyblank CityType a label
Legal Information
Have you ever been charged (excluding minor traffic violations) with a civil or criminal offense. misdemeanor or felony)?
No/Yes (if yes, please complete the below)*

YesNo
Offense type Date type City type State type Law Enforcement Agency Arresting you type
Offense type Date type City type State type Law Enforcement Agency Arresting you type
Offense type Date type City type State type Law Enforcement Agency Arresting you type
Have you ever been convicted (excluding minor traffic violations) with a civil or criminal offense, misdemeanor or felony)?
No/Yes (if yes, please complete the below)*

YesNo
Offense type Date type City type State type Results type
Offense type Date type City type State type Results type
Offense type Date type City type State type Results type
Applicant's Statement
The information contained in this questionnaire is correct to the best of my knowledge. I understand that a criminal history check will be obtained on me. In consideration of the receipt and evaluation of this questionnaire by Redeemer Christian School/New Life Church, I hereby release any individual, church or organization, both collectively and individually, from any and all liability for damages or whatever kind or nature which may at any time result to me, my heirs or family on account of compliance or any attempts to comply, with this authorization.
- I understand my employment or volunteer status will be contingent upon the results of this background check.
- Should my employment/volunteering be accepted, I agree to refrain from unscriptural conduct.
- I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF, AND SIGN THIS RELEASE AS MY OWN FREE ACT.
This is a legally binding agreement which 1 have read and I understand.
Signature*

Clear
Should be Empty:

Background Check Questionnaire

Personal Information

Previous Names

Previous Residences

Legal Information

Applicant's Statement